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VA HB 1444 passed through the State Senate!

Vision care plans; reimbursement for services. Prohibits a participating provider agreement between a vision care plan carrier and an optometrist or ophthalmologist from establishing the fee or rate that the optometrist or ophthalmologist is required to accept for the provision of health care materials or services, or from requiring that an optometrist or ophthalmologist accept the reimbursement paid by the vision care plan carrier as payment in full, unless the services or materials are covered services or covered materials under the applicable vision care plan. Reimbursements by a vision care plan carrier are required to be reasonable, which is defined as the negotiated fee or rate that is set forth in the participating provider agreement and is acceptable to the provider. Vision care plans shall not require an optometrist or ophthalmologist to use a particular optical laboratory, manufacturer of eyeglass frames or contact lenses, or third-party supplier as a condition of participation in a vision care plan. Changes to a participating provider agreement shall be submitted in writing to the optometrist or ophthalmologist at least 30 days prior to their effective date. Provisions of this measure that relate to covered materials also apply to licensed opticians practicing in the Commonwealth. The State Corporation Commission does not have jurisdiction to adjudicate individual controversies arising out of this measure.

The VCP lobbyists were all over this. The only thing they got back was a start date of Jan 1 2016. The original date was July 1 2015. VCPs said they needed more time to make changes to their plans.

I'm looking for some real shady shenanigans between now and then. EM could use this to cancel independent practice contracts and drive business directly to their "house" brands like Lenscrafters, Pearle, Target, etc., but VSP doesn't have that kind of retail optometry network but could offer significant induc. We shall see.

This legislation was initially introduced last year, but without enough time to complete the process. I'm sure the VCPs have had adequate time to have an alternative plan or plans in place. It will be interesting to watch.

Do you think that establishing a preferred network of labs may have been a way to test how far they could push their providers before an open revolt?

Hopefully, this is like Smaug's missing scale in the Hobbit. Optometry needs to find their black arrow and fast. Strike while the opening is there, and the beast will fall. At least it worked for Tolkein. ;)

"The State Corporation Commission does not have jurisdiction to adjudicate individual controversies arising out of this measure." Maybe it's just me, but the whole thing seems very vague, and lot's of ways out, especially this.

You need ECP's who are active politically and who are willing to work as a cohesive group. Opticians in VA had to flood the legislature with requests to be included in the language of the bill. I'm not sure that the ODs were happy about it, but we did bring more visibility to the bill.

I would think VCP's will do what VSP does, incentivize use of their labs/products. More re-imbursement for using Davis lab rather than another lab as example.

Originally Posted by obxeyeguy

"The State Corporation Commission does not have jurisdiction to adjudicate individual controversies arising out of this measure." Maybe it's just me, but the whole thing seems very vague, and lot's of ways out, especially this.

^^ these points are valid. It's a valiant effort overall but the reality is the manage care co's will simply adjust reimbursements in ways that will simply not be beneficial to exercise a greater choice of products or service providers. You'll have choice, but it won't make sense to take exercise those options. Same with clients, materials of choice will be made no-brainer options and others more painful thus consumers won't "choose" them. More and more labs will face the same touch choices and suffocate to slow death. Do the people fronting these bills really not see this coming? Dumb.

^^ these points are valid. It's a valiant effort overall but the reality is the manage care co's will simply adjust reimbursements in ways that will simply not be beneficial to exercise a greater choice of products or service providers. You'll have choice, but it won't make sense to take exercise those options. Same with clients, materials of choice will be made no-brainer options and others more painful thus consumers won't "choose" them. More and more labs will face the same touch choices and suffocate to slow death. Do the people fronting these bills really not see this coming? Dumb.

I'll take the bait. As the wheel in Washington keeps on turnin, we, the people of The Peoples Republic of America are supposed to accept lousy products and services in all walks of life. It is "dumb" to believe we even have a say in the matter.

But, getting back to the point, the labs will suffocate in the current environment anyway, so whats the harm in their trying it a different way? Perhaps (call me crazy) those that provide the best service will thrive in the new environment where everyone has the right to make a choice (even if many decide to take the lowest cost choice, at least that would be a conscious decision rather than the result of a mind-numbing brainwash treatment we are getting from VCPs now).

This VCP thing has really gotten out of hand. Insurance should provide coverage for catastrophic events, and perhaps (depending on the situation) regular checkups and basic materials. It is a matter of public safety for drivers to have current eyeglass Rx and to have adequate help with night glare and sun glare. If you want a designer frame, cosmetically lighter / thinner lenses, HD vision so you can see an ant's antlers on Christmas Eve that should be something that people should pay for out of their own pocket.

LET THERE BE CHOICE ... for this is still the US & A, the nation that is supposed to treat an individual as an INDIVIDUAL.

I'll take the bait. As the wheel in Washington keeps on turnin, we, the people of The Peoples Republic of America are supposed to accept lousy products and services in all walks of life. It is "dumb" to believe we even have a say in the matter.

No bait tossed out there, just an opinion. You're not being forced to accept lousy products or services. Opt-in or out as you please. We don't take Spectera, you don't have to either. In fact we're not forced to take any products or services. I run a very healthy and prosperous practice as to many, many ECP's and do so with the options of taking VCP's. Most of us do and do quite well. However, none are forced to do so.

But, getting back to the point, the labs will suffocate in the current environment anyway, so whats the harm in their trying it a different way?

Fair point, for some, but not all. Honestly, is it really fair for those that are doomed to try and force their existence upon a marketplace that isn't either capable or willing to support them? The reality is the market today has too many labs. The independent labs and my fellow colleagues put the independents in this situation through their own practices of enabling and buying into the Essilors bait. Face it, without Big E's massive and fast consolidation enabled by the market itself those labs would still be around and doing just fine. Some attrition would have occurred but that's with any market. The ones that still exist have proven the model of doom didn't have to be followed. Perhaps those are the ones that should remain standing?

Perhaps (call me crazy) those that provide the best service will thrive in the new environment where everyone has the right to make a choice (even if many decide to take the lowest cost choice, at least that would be a conscious decision rather than the result of a mind-numbing brainwash treatment we are getting from VCPs now).

How does that not exist now? Face it the legislation in place is there to fend off the likes of Davis, Spectera both of whom are horrible and with the small percentage of the market they serve, no one is "forced" to take them. Same with EyeMed and VSP. Happy to debate those two next. In the end though, do patients not already have a choice to do exactly what you state? They don't have to exercise their opt-in to VCP's but they do. Even still they don't have to use those benefits.

Shouldn't the consumers be allowed to live in an environment where they too have the right to make a choice? Let me paraphrase your comment as it's fitting: (even if they, the consumers, decide to take the lowest cost choice) Should consumers be forced to use ECPs that in turn are attempting to take away their savings and benefits of their VCP's? That knife cuts both ways. VCP exist for the consumer first.

This VCP thing has really gotten out of hand. Insurance should provide coverage for catastrophic events, and perhaps (depending on the situation) regular checkups and basic materials.

Really? VCP's aren't just insurance plans. VCP's are often simply just a means for the client to out-source having to manage their own claims; stick to what it is they do best. VCP plans often involve simply administering the plan for the client with the clients own money, whether that money be paid from their pocket and/or that of their employees. Again, it's not really just simply an insurance plan but a cost savings structure for all. One that doctors opt-into. You know this.....

It is a matter of public safety for drivers to have current eyeglass Rx and to have adequate help with night glare and sun glare. If you want a designer frame, cosmetically lighter / thinner lenses, HD vision so you can see an ant's antlers on Christmas Eve that should be something that people should pay for out of their own pocket.

So do you think your statement above would be one the average consumer would agree with? The fact consumers pay to belong to Sam's Club and Costco on top of opting into Dental and Vision plans with the explosive growth all of those have seen, I would say the answer is clearly NO; They wouldn't. Consumers are opting into discount plans because they indeed see value in them. Disagree all you want, the market is speaking loud and clear. Shouldn't that decision lie with the consumer? To do otherwise and allow you or me or the other ECP's to make that decision for them would be pretty self-serving don't you think?

LET THERE BE CHOICE ... for this is still the US & A, the nation that is supposed to treat an individual as an INDIVIDUAL.

How is there not currently choice?
I can opt-into or out of the plans
I can opt to cut lenses in my office
I'm not limited on products I can dispense

Legislation like this simply increase the likelihood that changes impacting reimbursements and options down the road will be less than they are today. If the system today doesn't work for you then don't participate in them. Pretty simple. Those of us that participate and do very well are going to be ticked if the pending changes cost us money or make life more difficult simply to support those that complain.

I'm looking for some real shady shenanigans between now and then. EM could use this to cancel independent practice contracts and drive business directly to their "house" brands like Lenscrafters, Pearle, Target, etc., but VSP doesn't have that kind of retail optometry network but could offer significant induc. We shall see.

^^ exactly. However I don't see anyone being removed from the panel vs just made to starve themselves off the panel. again, does anyone not think these things through? VSP does have retail options and an entire network of options. Again, any VCP can make just a few minor changes that will impact large groups of labs and ECP's in ways that could be worse than what those supporting this legislation face today. What you call shady shenanigans will likely come down as a simple set of changes in response to these types of bills. I call those the devil you don't know....

I think race pointed out that the choice of products and labs already lies in the hands of providers. Just as choice of providers lies in the hands of consumers. I work in a large medical complex. I know many doctors here that are out of network on ALL insurance plans. They'll accept what your plan will pay them as out of network, but the patient must pay the difference.

Why don't these doc's not starve, lack patients? Because of excellence of care. These doctors have built a reputation as the best there is around at what they do. Are they really better? Perhaps not, but they are perceived as superior by these patients.

This is how we've carved out our niche here. We accept no VCP, yet thrive so well, we're opening up our 3rd location this summer. I'm in an over saturated area in Houston. We have more than 20 OD's/MD's within a 4 mile radius of us. We've recently had a new group come in down the road advertising free eye exams with the purchase of two pair SV's for 64 bucks! (Why have vision insurance when you can source services that cheap). Yet, I find it of little concern since they are not catering to my patient base.

Back to choice of lenses/labs. It will go down just as race stated. There will be more reimbursement when providers choose plan products. Don't like the product or lab? Simple, convince your patients that better products exist...At an added fee. Most of my patients have some form of a VCP. Some walk when they don't understand they can use out of network benefits to get the excellence they are looking for. But enough do "get it" to keep us busy.

Ahh, but shouldn't the choice of products and labs be determined by the practitioner and not the VCPs? That's not really "vision care" is it?

Are practitions choosing those products and labs based on what's best for them or the patient first?
Is what the VCP's doing any different than what you're suggesting the practitioners be allowed to do?

I see manufacturer agreements from Essilor & Hoya and others all over. I'm approached all the time to sign them.

I see private label lenses from labs that make everyone more money first....and are just as good / better than others. Blah, Blah, Blah. It's about money.

I see "under the table deals" and spiffs to my staff.

I see VisionSource, etc. masquerading their franchise model as some sort of helpful buying group that will save the world from the evil doers.

Please, let's not pretend that the majority of practitioners complaining are doing so soley for the benefit of the patient. They aren't. It's a WIIFM world and they/we are no different than the VCP's being made to be the villain. Patients want to see better and most all the products out there will provide what you call "visoin care" and help them achieve that goal. Those practitoiners you mention need to realize that when the practitioner control the patient, they can make those decisions. On VCP's they control the patient and yes to a large extent the decisions we are discussing here. That's still vision care.

I'm not sure what specific products or labs you're referencing, but somewhere along the way to those decisions comes costs that are involved. What you're seeing in the market is nothing more than a controlling of materials and labor costs in motion. Would practitioners be willing to half their reimbursements to garner more choices? Would the labs do that too? You work for a lab right? Last I checked you're lab is setting themselves up to survive by "buying into" a lot of the VCP offers too.

Options abound and I'm sure some of these points may be made by choice and some perhaps will be forced upon those asking for these "choices" One thing is for sure, no matter what happens, there will always be people claiming to be victims crying about the decisions. In the end, independent labs and contract labs are needed far less now that the big boys have their own and are building a network to support their members. They are struggling with that in hopes that they will be one of the few remaining when the implosion occurs; and it will occur.

Same with the practitioners. We're all out trying to maintain and build a practice with patients that are no longer just loyal to us for our offerings. They are controlled by the savings that their VCP offers and that loss of control is what's driving this outrage. Practitioners are really just contracted service providers now and they don't like the loss of control that's happens over the years.

Welcome to the world of consolidation where what you wish for might just be the worst thing to happen to you.

VSP is the one that stands to lose the most. Their (no-) Choice Plan is a big seller for them.

Yes/No. What's to lose? They approached the no-choice model in a much different way than the other VCP's that are being targeted by legislation. They don't require you take their plans, they offer choice in products and in many cases choices in labs too. Again, be careful what you wish for in some respects as you might just get a worse plan that what you have today. Think it through before you cast your vote. IMO, work the plan before you vs demanding one you know won't be as good.

This is how we've carved out our niche here. We accept no VCP, yet thrive so well, we're opening up our 3rd location this summer. I'm in an over saturated area in Houston. We have more than 20 OD's/MD's within a 4 mile radius of us. We've recently had a new group come in down the road advertising free eye exams with the purchase of two pair SV's for 64 bucks! (Why have vision insurance when you can source services that cheap). Yet, I find it of little concern since they are not catering to my patient base
Back to choice of lenses/labs. It will go down just as race stated. There will be more reimbursement when providers choose plan products. Don't like the product or lab? Simple, convince your patients that better products exist...At an added fee. Most of my patients have some form of a VCP. Some walk when they don't understand they can use out of network benefits to get the excellence they are looking for. But enough do "get it" to keep us busy.

Key words here "patient base". To those reaching to the masses, your practice is in a down spin. To those of us that have built on what 24/7 said, excellence, we will do fine. I'd rather see 8 sales a day at what I charge, than 16 at what I was getting from VSP and Eyemed.

Yes/No. What's to lose? They approached the no-choice model in a much different way than the other VCP's that are being targeted by legislation. They don't require you take their plans, they offer choice in products and in many cases choices in labs too. Again, be careful what you wish for in some respects as you might just get a worse plan that what you have today. Think it through before you cast your vote. IMO, work the plan before you vs demanding one you know won't be as good.

I'm for choice, no doubt. I'm "pro-choice" in VCPs.

I don't think it's "illegal" for VCPs to go vertical. I don't think it's "illegal" for VCPs to have formularies for lenses, frames, etc.

The public will get what (their employer) pays for, however.

Increasingly, their employers are spending about $200/head for a $200 gift certificate and a phony 20% off coupon to Lenscrafters or "The VSP Retail Outlets" to be spent on a limited selection of (VCP-owned or affiliated) lenses and frames.

I think eventually it will become clear to the employers that their money isn't really going to a "vision plan", it's going to a retailer. At that point the jig is up.